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Sleepwalking

Sleepwalking, or somnambulism, occurs most often in children 6 to 12 years old and is generally benign, although repeated episodes deserve investigation. The subject appears awake, but is not, and will not remember his actions.

Definition

This is a sleep disorder characterized by walking or other activity while seemingly still asleep. Other names for it are walking during sleep and somnambulism.

The normal sleep cycle involves distinct stages from light drowsiness to deep sleep. in rapid eye movement (REM) sleep, the eyes move rapidly and vivid dreaming is most common. During the night, there will be several cycles of non-REM and REM sleep. Sleepwalking most often occurs during deep non-REM sleep (stage 3 or stage 4 sleep) early in the night. It can occur during REM sleep near morning.

Sleepwalking may include simply sitting up and appearing awake while actually asleep, getting up and walking around, or complex activities such as moving furniture, going to the bathroom, dressing and undressing, and similar activities. Some people even drive a car while actually asleep. The episode can be very brief (a few seconds) or it can last 30 minutes or longer.

It is not dangerous to awaken a sleepwalker, although it is common for the person to be confused or disoriented for a short time upon awakening. Another misconception is that a person cannot be injured when sleepwalking. Actually, injuries—caused by tripping and loss of balance—are common for sleepwalkers.

Sleepwalking occurs at any age, but it occurs most often in children 6 to 12 years old. It may occur in younger children, in adults, or in the elderly, and it appears to run in families.

Symptoms

Eyes open during sleep

May have blank facial expression

May sit up and appear awake during sleep

Walking during sleep

Any sort of detailed activity during sleep

No recall of the event upon awaking

Confusion, disorientation upon awakening

Talking is incomprehensible and non-purposeful

Causes

In children, the cause is usually unknown but may also be related to fatigue, prior sleep loss, fever, or anxiety. In adults, sleepwalking is usually associated with a disorder of the mind but may also be seen with reactions to drugs and/or medications and alcohol, and medical conditions such as partial complex seizures. In the elderly, sleepwalking may be a symptom of an organic brain syndrome or REM behavior disorders.

Usually, no further examination and testing are necessary. If sleepwalking is frequent or persistent, examination to rule out other disorders (such as partial complex seizures) may be appropriate. It may also be appropriate to undergo a psychological evaluation to determine causes such as excessive anxiety or stress, or medical evaluation to rule out other causes.

Treatments

Usually no specific treatment for sleepwalking is needed.

Safety measures may be necessary to prevent injury. This may include modifying the environment by moving objects such as electrical cords or furniture to reduce tripping and falling.

In some cases, short-acting tranquilizers have been helpful in reducing the incidence of sleepwalking.

Sleepwalking may or may not become less frequent with age. It usually does not indicate a serious disorder, although it can be a symptom of other disorders. Improving sleep cycle may help decrease occurrence of sleepwalking.

Prevention

Avoid the use of alcohol or central nervous system depressants if prone to sleepwalking.

Avoid fatigue or insomnia, because this can instigate an episode of sleepwalking.

Avoid or minimize stress, anxiety, and conflict, which can worsen the condition.

Tips for a Good Night's Sleep

Set a schedule:

Set a schedule

Go to bed at a set time each night and get up at the same time each morning.Disrupting this schedule may lead to insomnia.

"Sleeping in" on weekends also makes it harder to wake up early on Monday morning because it re-sets your sleep cycles for a later awakening

Exercise

Try to exercise 20 to 30 minutes a day. Daily exercise often helps people sleep. However, a workout before bedtime may interfere with sleep. For maximum benefit, try to get your exercise about 5 to 6 hours before going to bed.

Avoid caffeine, nicotine, and alcohol

Caffeine acts as a stimulant and keeps people awake. Sources of caffeine include coffee, chocolate, soft drinks, non-herbal teas, diet drugs, and some pain relievers. Smokers tend to sleep very lightly and often wake up in the early morning due to nicotine withdrawal. Alcohol robs people of deep sleep and REM sleep and keeps them in the lighter stages of sleep.

Relax before bed

A warm bath, reading, or another relaxing routine can make it easier to fall sleep. You can train yourself to associate certain restful activities with sleep and make them part of your bedtime ritual.

Sleep until sunlight

If possible, wake up with the sun, or use very bright lights in the morning. Sunlight helps the body's internal clock reset itself each day. Sleep experts recommend exposure to an hour of morning sunlight for people having problems falling asleep.

Don't lie in bed awake

If you can't get to sleep, don't just lie in bed. Do something else, like reading, watching television, or listening to music, until you feel tired. The anxiety of being unable to fall asleep can actually contribute to insomnia.

Control your room temperature

Maintain a comfortable temperature in the bedroom. Extreme temperatures may disrupt sleep or prevent you from falling asleep.

See a doctor if your sleeping problem continues

If you have trouble falling asleep night after night, or if you always feel tired the next day, then you may have a sleep disorder and should see a physician. Your primary care physician may be able to help you. You can also find a sleep specialist at a major hospital near you. Most sleep disorders can be treated effectively.